When her mother questioned the doctor about the diagnosis and tried to explain that this was her first time hearing that her son has asthma, Josseline said the doctor bluntly told her mom, “This is why I don’t trust you people.” According to the doctor, Josseline’s brother’s records showed a history of asthma and a prescription to manage it. But Josseline’s mom’s understanding from their last visit was that her son had a fever, and the prescribed inhaler was to be used temporarily until his breathing improved. Josseline and her family live in Hempstead, New York, but she and her mom are originally from Guatemala. And when her mom relied on a receptionist for the information about her son’s diagnosis, the receptionist had not translated correctly. This situation is unfortunately not uncommon in America’s Latino community. Although they make up the biggest racial and ethnic group in the United States, accounting for 18 percent of the population, according to an article published in August 2021 in JAMA Network, Latinos still face multiple barriers to accessible healthcare, including a language barrier, high medical costs, and cultural insensitivity. These issues could be part of the reason that Latinos are the racial group that’s least likely to go to the doctor: According to the U.S. Census, 42 percent of Latinos went a full year without seeing a doctor, compared to 22 percent and 30 percent of white and Black populations, respectively, who did not see a doctor in the same time span. Coupled with this is a downward trend in doctor’s visits in general: Between 2008 and 2016, visits to primary care providers were down 24 percent even among adults with private health insurance, according to a study published in February 2020 in the Annals of Internal Medicine. Not seeing a doctor regularly has consequences. Latinos have higher percentages of poorly controlled high blood pressure, obesity, and death rates from diabetes than white people — health issues that are often preventable, according to the Centers for Disease Control and Prevention (CDC). In addition, Latinos are more than twice as likely to be hospitalized for COVID-19 than white people, largely a result of long-standing systemic health and social inequities, according to the CDC. While going to the doctor can be an intimidating experience for anyone, not being a native English speaker, or living in a culture that’s different from where you grew up, can make it even scarier. But getting regular checkups is an essential part of a preventive healthcare plan. For Latinos whose experiences at the doctor’s office has been less than ideal or who are hesitant to take that first step in making an appointment, here are some things to consider before and during a doctor’s visit for yourself or with a loved one.
Does the Doctor Only See Patients Who Have Health Insurance?
A significant barrier to healthcare is the price tag. Jacqueline Beyer, RN, a family nurse practitioner at the Clinica Medica Hispana in Houston, says most of her patients work multiple jobs, many of which are not full-time; they may be working three part-time jobs, for example, and sending part of their earnings back to their home country to support their families there. So paying hundreds of dollars for health insurance each month isn’t realistic when they’re already stretched financially — a factor contributing to the fact that Latinos have the highest uninsured rates of any ethnic group, with 18.7 percent lacking health insurance in 2019, according to the U.S. Department of Health and Human Services Office of Minority Health. Some good news is that you don’t always need insurance to go to the doctor: Community health clinics are a good option for low-cost care. “The federal government covers the costs of community health centers, and they’re usually in areas with fewer doctors. This is great for patients that don’t have a lot of money or are uninsured,” says Elena V. Rios, MD, MSPH, president and CEO of the National Hispanic Medical Association. In addition, the Health Resources and Services Administration (HRSA) says that Federally Qualified Health Centers — HRSA-funded community-based healthcare providers in underserved areas — must provide care at a fixed cost based on your income. Depending on the service, Dr. Rios says a doctor could charge as little as $15 to $50 per visit.
What Are Your Patient Rights?
If you’re sick, chances are you might want to go to a doctor. Yet fear of deportation can make some immigrants hesitant to make the visit, and recent events have not helped: A study published in March 2021 in JAMA Network Open found that undocumented patients sought less medical care during and after former President Donald Trump’s 2016 campaign given the rise in anti-immigrant rhetoric. Existing policies can also act as barriers. The Affordable Care Act (ACA), for example, excludes the country’s estimated 7.1 million undocumented immigrants from eligibility for coverage, which limits their means for having a primary care doctor, according to an article published in May 2020 in The New England Journal of Medicine. As a result, they often rely on emergency departments for their medical care, many of which have been filled beyond capacity during the coronavirus pandemic. Both emergency rooms and government-funded clinics cannot ask about your citizenship status, according to Rios, but doctors in private practice may.
Is There a Latino Doctor Available?
People prefer doctors who look like them, as a study published in November 2020 in JAMA Network Open shows. For example, while only 5.8 percent of doctors in the United States identify as Hispanic, according to the Association of American Medical Colleges, Rios says Hispanic doctors tend to have more patients from the same ethnic group. Having a shared identity helps people open up when they feel there’s no bias against them. “Patients are especially thrilled if it’s someone from their country — it’s just refreshing to speak your language,” says Beyer. “When you talk in your first language, you’re more descriptive. You’re not just saying that you’re in pain, but you get to explain what your symptoms are and how you’re feeling.”
Is There a Clinic in My Community?
Doctors who understand a patient’s experience will better grasp their needs, so finding a clinic in your community is ideal: Someone local is better able to understand how you live and what challenges you could be up against. “Our communities have a lot of issues, and only doctors that come from those communities understand what to talk about with patients,” says Rios. Many doctors advise exercising, for example, but if you don’t have safe parks or sidewalks close by, you’ll feel less inclined to walk, Rios explains — in which case other options should be discussed.
Is the Office Accessible and Easy to Navigate?
Beyond affordability is accessibility. Beyer says some doctors understand that patients often work odd hours when offices are usually closed, or they don’t receive paid time off. So one thing to consider is finding a doctor who provides early or late-night hours. Another factor to consider is the resources available for navigating paperwork, which can be overwhelming for anyone. Josseline’s mom is not familiar with a lot of current technology, for example, so using a tablet to fill out medical forms is a challenge for her. Having a paper version or a document in Spanish makes a big difference in accurately entering medical information. If you qualify for insurance and have questions about enrolling or about your coverage, Rios says community health workers, known as patient navigators, are hired by state governments under the ACA to go to local neighborhoods and help people fill out applications for insurance. Once you’re in the doctor’s office (or prior to going), office managers and staff should be able to answer billing questions such as whether the doctor accepts your insurance, or if there are any copays.
Is a Professional Translator Available?
Latinos with limited English proficiency are less likely to delay care when the doctor speaks Spanish, reports a study published in March 2020 in the Journal of the Society for Social Work and Research. If a Spanish-speaking doctor is not available, bringing a relative who is fluent in English to translate is another option. But your medical history is a personal discussion, and Rios says having a family member translate can be intrusive and upsetting if there’s bad news. In Josseline’s case, having a professional translator could help her mom understand medical jargon. “I speak English, and I’m fluent in Spanish. If you explain things to me, I will translate to my mom the best I can,” she says. “But there are some terms I probably have to Google, because I am not a doctor.” When looking for a doctor, ask if there are certified medical interpreters. Under the Affordable Care Act, doctors are required to provide translation services free of charge to the patient. All doctor’s offices and hospitals must have qualified translators, though the idea of a “qualified” interpreter varies depending on who you ask, according to an article published in January 2018 in the Annals of Family Medicine. For instance, some hospitals require translators to be certified as a medical interpreter, but Rios says doctor’s offices tend to rely on staff members who know another language but may not be used to translating. “Look at the court system — they have professional translators because they’re dealing with legal issues,” says Rios. “But in the medical field, it’s thought of as a courtesy, like ‘Oh, let me get this [nonprofessional] translator to help, not realizing how important it is to correctly explain diseases or life and death issues,” she says, adding that a patient could up getting worse if they don’t get the correct information about a diagnosis and treatment — as well as what they need to do to take care of themselves.
How to Prepare for Your Doctor’s Visit: Be Sure to Come With Your Full Medical History, Including Your Family’s
Even if you’re not sick, it’s important to see a doctor each year for an annual physical. “We find people who’ve had diabetes for years, and they only find out when they come in for something else, like a respiratory infection,” says Beyer. “It’s not until we do blood work that we find their sugar levels are through the roof. But by that time, there’s too much damage to the body from the high blood sugars or high blood pressure that has built up over time.” By budgeting for preventive care, your doctor can support your overall health rather than just treat current symptoms. It’s also important to share your full medical and medication history with your doctor, as well as your family’s medical history, so be sure to gather all of that information ahead of your appointment — and honestly is always the best policy. Beyer says that many of her Hispanic patients tend to use nonprescribed treatments from their country or other herbal remedies before going to the doctor, for example, so she says she likes to directly ask, “What medicines have you been taking?” Off-label use of drugs, such as taking tetracycline — an antibiotic for acne — for three days for a fever is not uncommon, she says. In addition, some people might be reluctant to disclose alcohol or illicit drug use to their doctor for fear of judgment or retribution, but Beyer says knowing this information helps in understanding her patients’ expectations for the visit and providing an opportunity for explaining why she might pursue a different approach to treatment. The information is also vital for an accurate picture of your overall health, and doctors are prohibited from sharing patient information as part of the Health Insurance Portability and Accountability Act (HIPAA). If you’re Latino and looking for a new doctor, choosing someone who is also Latino or culturally inclusive can help you build a trusting relationship that makes you feel more secure in sharing all aspects of your medical history.
